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Compliance with follow‐up Test of Cure and outcomes after treatment for high‐grade cervical intraepithelial neoplasia in Victoria, Australia
Author(s) -
Tan Jeffrey H.J.,
Malloy Michael J.,
Brotherton Julia M.L.,
Saville Marion
Publication year - 2020
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13115
Subject(s) - medicine , cervical screening , incidence (geometry) , cervix , retrospective cohort study , biopsy , cervical intraepithelial neoplasia , obstetrics , cervical cancer , cohort , cytology , gynecology , surgery , cancer , pathology , physics , optics
Background Test of Cure (ToC), a combination of testing for oncogenic human papillomavirus (HPV) and cytology, at 12 months post‐treatment and annually thereafter, was approved in Australia in 2005 for follow‐up of women treated for high‐grade squamous intraepithelial lesions (HSIL) of the cervix. Aims To determine among women resident in Victoria, Australia, the compliance with ToC and the incidence of recurrence up to five years after successful ToC. Materials and Methods A retrospective analysis of women with HSIL (diagnosed at pre‐treatment punch biopsy or at excision) who had excisional treatment between 1 January 2007 and 31 December 2011. De‐identified data were retrieved from the Victorian Cervical Cytology Registry in Melbourne as at 24 April, 2015. Successful ToC is defined as the occurrence of two consecutive normal (negative) co‐tests. Recurrence after treatment is defined by histologically detected HSIL or greater. Results There were 8478 women who had excisional treatment for HSIL, with 448 (5.5%) experiencing recurrence. Only 2253 (26.6%) women successfully completed ToC, with a decreasing likelihood of ToC completion by time since year of treatment (32.0% in 2007 compared with 20.9% in 2011). Only one (0.08%) woman had HSIL on histology after successful ToC. From the 2007 cohort, 555 (32.0%) women completed ToC successfully and no HSIL recurrence occurred thereafter (median subsequent follow‐up period of 4.7 years). Conclusions Our study confirmed that women who successfully complete ToC can be returned to five‐year routine screening. However, more concerted efforts are needed to ensure that all women treated complete ToC.